Presentation on Sexual Dyfunctions Abnormal Psycholoy Clinical Psychology DSM-V It will help clinical Psychologists as well as students so must read and share as well with others. This one is first compelete presentation on secual dysfunctions. Its very easy and understandable. Its purely based on DSM-v.

1. ARJMAND NAZ
MS CLINICAL PSYCHOLOGY
GOVERNMENT COLLEGE UNIVERSITY FAISALABAD
PUNJAB, PAKISTAN

2. SEXUAL DYSFUNCTIONS

3. SEXUAL RESPONSE CYCLE
Excitement
Plateau
Orgasm
Resolution

4. WHAT IS SEXUAL DYSFUNCTION?
Any problem that occurs during any phase
of sexual response cycle.
It prevent the individual or couple from
the sexual activity.

5. DYSFUNCTION CAN BE COMMON!
It can effect any gender at any age
It is more common in ages 40-65
because of decline due to aging
43% of women have reported some
kind of dysfunction
31% of men have reported it

6. TYPES OF SEXUAL DYSFUNCTIONS
 Delayed Ejaculation 92.74 (F52.32)
 Erectile Disorder 92.72 (F52.21)
 Female Orgasmic Disorder92.73 (F52.31)
 Female Sexual Interest/ Arousal Disorder 92.72 (F52.22)

7. SEXUAL DYSFUNCTIONS
 Genito-Pelvic Pain/ Penetration Disorder92.76 (F52.6)
 Male Hypoactive Sexual Desire Disorder 302.71 (F52.0)
 Premature (Early) Ejaculation 302.75 (F52.4)

8. SPECIFIED AND UNSPECIFIED
 Other Specified Sexual Dysfunction 302.79 (F52.8)
 Unspecified Sexual Dysfunction 302.70 (F52.9)

9. DELAYED EJACULATION
A. Either of the following symptoms must be experienced on almost all
or all occasions (approximately 75%-100%) of partnered sexual
activity (in identified situational contexts or, if generalized, in all
contexts), and without the individual desiring delay:
1. Marked delay in ejaculation.
2. Marked infrequency or absence of ejaculation.
B. The symptoms in Criterion A have persisted for a minimum
duration of approximately 6 months.
C. The symptoms in Criterion A cause clinically significant distress in
the individual.
D. The sexual dysfunction is not better explained by a nonsexual
mental disorder or as a consequence of severe relationship distress
or other significant stressors and is not attributable to the effects of a
substance/medication or another medical condition.

10.  Specify whether:
Lifelong: The disturbance has been present since the individual
became sexually active.
Acquired: The disturbance began after a period of relatively normal
sexual function.
 Specify whether:
Generalized: Not limited to certain types of stimulation, situations, or
partners.
Situational: Only occurs with certain types of stimulation, situations,
or partners.

11.  Specify current severity:
Mild: Evidence of mild distress over the symptoms in Criterion A.
Moderate: Evidence of moderate distress over the symptoms in
Criterion A.
Severe: Evidence of severe or extreme distress over the symptoms in
Criterion A.

12. ASSOCIATED FEATURES SUPPORTING
DIAGNOSIS
The following five factors must be considered during assessment and
diagnosis of delayed ejaculation, given that they may be relevant to
etiology and/or treatment:
1) Partner factors (e.g., partner's sexual problems, partner's health
status);
2) Relationship factors (e.g., poor communication, discrepancies in
desire for sexual activity);
3) Individual vulnerability factors (e.g., poor body image; history
of sexual or emotional abuse), psychiatric co-morbidity (e.g.,
depression, anxiety), or stressors (e.g., job loss, bereavement);
4) Cultural/religious factors (e.g., inhibitions related to prohibitions
against sexual activity; attitudes toward sexuality); and
5) Medical factors relevant to prognosis, course, or treatment. Each
of these factors may contribute differently to the presenting
symptoms of different men with this disorder.

13. PREVALENCE
Prevalence is unclear because of the lack of a precise
definition of this syndrome. It is the least common male
sexual complaint.

14. RISK AND PROGNOSTIC FACTORS
Genetic and physiological:
Age-related loss of the fast-conducting peripheral sensory nerves and
age-related decreased sex steroid secretion may be associated with
the increase in delayed ejaculation in men older than 50 years.

15. DD AND CO-MORBIDITY
Delayed Ejaculation
 Another medical condition.
 Substance/Medication use
 Dysfunction with orgasm
There is some evidence to suggest
that delayed ejaculation may
be more common in severe
forms of major depressive
disorder.
Differential Diagnosis Co-morbidity

16. ERECTILE DISORDER
A. At least one of the three following symptoms must be experienced
on almost all or all (approximately 75%-100%) occasions of sexual
activity (in identified situational contexts or, if generalized, in all
contexts):
1. Marked difficulty in obtaining an erection during sexual activity.
2. Marked difficulty in maintaining an erection until the completion of
sexual activity.
3. Marked decrease in erectile rigidity.
B. The symptoms in Criterion A have persisted for a minimum duration
of approximately 6 months.
C. The symptoms in Criterion A cause clinically significant distress in
the individual.
D. The sexual dysfunction is not better explained by a nonsexual
mental disorder or as a consequence of severe relationship distress
or other significant stressors and is not attributable to the effects of a
substance/medication or another medical condition.

17. o Specify whether:
Lifelong: The disturbance has been present since the individual
became sexually active.
Acquired: The disturbance began after a period of relatively normal
sexual function.
o Specify whether:
Generalized: Not limited to certain types of stimulation, situations, or
partners.
Situational: Only occurs with certain types of stimulation, situations,
or partners.
 Specify current severity:
Mild: Evidence of mild distress over the symptoms in Criterion A.
Moderate: Evidence of moderate distress over the symptoms in
Criterion A.
Severe: Evidence of severe or extreme distress over the symptoms in
Criterion A.

18. RISK AND PROGNOSTIC FACTORS
 Temperamental:
Neurotic personality traits may be associated with erectile problems in
college students, and submissive personality traits may be associated
with erectile problems in men age 40 years and older. Alexithymia
(i.e., deficits in cognitive processing of emotions) is common in men
diagnosed with "psychogenic" erectile dysfunction. Erectile
problems are common in men diagnosed with depression and
posttraumatic stress disorder.
 Course modifiers:
Risk factors for acquired erectile disorder include age, smoking
tobacco, lack of physical exercise, diabetes, and decreased desire.

19. DD AND CO-MORBIDITY
Erectile Dysfunction
Nonsexual Mental disorder
Normal Erectile function
Substance/Medication use
Another Medical condition
Other sexual dysfunctions.
Erectile disorder can be comorbid with
other sexual diagnoses, such as
premature (early) ejaculation and male
hypoactive sexual desire disorder, as
well as with anxiety and depressive
disorders. Erectile disorder is common
in men with lower urinary tract
symptoms related to prostatic
hypertrophy. Erectile disorder may be
comorbid with dyslipidemia,
cardiovascular disease, hypogonadism,
multiple sclerosis, diabetes mellitus,
and other diseases that interfere with
the vascular, neurological, or
endocrine function necessary for
normal erectile function.
Differential Diagnosis Co-Morbidity

20. FEMALE ORGASMIC DISORDER
A. Presence of either of the following symptoms and experienced on
almost all or all (approximately 75%-100%) occasions of sexual
activity (in identified situational contexts or, if generalized, in all
contexts):
o Marked delay in, marked infrequency of, or absence of orgasm.
o Markedly reduced intensity of orgasmic sensations
B. The symptoms in Criterion A have persisted for a minimum duration
of approximately 6 months.
C. The symptoms in Criterion A cause clinically significant distress in
the individual.
D. The sexual dysfunction is not better explained by a nonsexual
mental disorder or as a consequence of severe relationship distress
(e.g., partner violence) or other significant stressors and is not
attributable to the effects of a substance/medication or another
medical condition.

21. SPECIFY
 Specify whether:
Lifelong: The disturbance has been present since the individual
became sexually active.
Acquired: The disturbance began after a period of relatively normal
sexual function.
 Specify whether:
Generalized: Not limited to certain types of stimulation, situations, or
partners.
Situational: Only occurs with certain types of stimulation, situations,
or partners. Specify if: Never experienced an orgasm under any
situation.
 Specify current severity:
Mild: Evidence of mild distress over the symptoms in Criterion A.
Moderate: Evidence of moderate distress over the symptoms in
Criterion A.
Severe: Evidence of severe or extreme distress over the symptoms in
Criterion A.

22. PREVALENCE
Reported prevalence rates for female orgasmic problems in women
vary widely, from 10% to 42%, depending on multiple factors (e.g.,
age, culture, duration, and severity of symptoms); however, these
estimates do not take into account the presence of distress. Only a
proportion of women experiencing orgasm difficulties also report
associated distress. Variation in how symptoms are assessed (e.g.,
the duration of symptoms and the recall period) also influence
prevalence rates. Approximately 10% of women do not experience
orgasm throughout their lifetime.

23. RISK AND PROGNOSTIC FACTORS
Temperamental:
A wide range of psychological factors, such as anxiety and concerns about pregnancy,
can potentially interfere with a woman's ability to experience orgasm.
Environmental:
There is a strong association between relationship problems, physical health, and mental
health and orgasm difficulties in women. Socio-cultural factors (e.g., gender role
expectations and religious norms) are also important influences on the experience of
orgasmic difficulties.
Genetic and physiological:
Many physiological factors may influence a woman's experience of orgasm, including
medical conditions and medications. Conditions such as multiple sclerosis, pelvic
nerve damage from radical hysterectomy, and spinal cord injury can all influence
orgasmic functioning in women. Selective serotonin reuptake inhibitors are known to
delay or inhibit orgasm in women. Women with vulvo-vaginal atrophy (characterized
by symptoms such as vaginal dryness, itching, and pain) are significantly more likely
to report orgasm difficulties than are women without this condition.

24. DD AND CO-MORBIDITY
Female Orgasmic Disorder
Nonsexual mental disorders.
Substance/medication-induced
sexual dysfunction.
Another Medical condition.
Women with female orgasmic
disorder may have co-
occurring sexual
interest/arousal difficulties.
Women with diagnoses of
other nonsexual mental
disorders, such as major
depressive disorder, may
experience lower sexual
interest/arousal, and this may
indirectly increase the
likelihood of orgasmic
difficulties.
Differential Diagnosis Co-morbidity
Interpersonal factors.

25. FEMALE SEXUAL INTEREST/AROUSAL
DISORDER
A. Lack of, or significantly reduced, sexual interest/arousal, as
manifested by at least three of the following:
1. Absent/reduced interest in sexual activity.
2. Absent/reduced sexual/erotic thoughts or fantasies.
3. No/reduced initiation of sexual activity, and typically unreceptive to
a partner’s attempts to initiate.
4. Absent/reduced sexual excitement/pleasure during sexual activity in
almost all or all (approximately 75%-100%) sexual encounters (in
identified situational contexts or, if generalized, in all contexts).
5. Absent/reduced sexual interest/arousal in response to any internal or
external sexual/erotic cues (e.g., written, verbal, visual).
6. Absent/reduced genital or non-genital sensations during sexual
activity in almost all or all (approximately 75%-100%) sexual
encounters (in identified situational contexts or, if generalized, in
all contexts).

26. B. The symptoms in Criterion A have persisted for a minimum duration
of approximately 6 months.
C. The symptoms in Criterion A cause clinically significant distress in
the individual.
D. The sexual dysfunction is not better explained by a non-sexual
mental disorder or as a consequence of severe relationship distress
(e.g., partner violence) or other significant stressors and is not
attributable to the effects of a substance/medication or another
medical condition.

27. SPECIFY
Specify whether:
Lifelong: The disturbance has been present since the individual
became sexually active.
Acquired: The disturbance began after a period of relatively normal
sexual function. Specify whether:
Generalized: Not limited to certain types of stimulation, situations, or
partners. Situational: Only occurs with certain types of stimulation,
situations, or partners.

28. Specify current severity:
Mild: Evidence of mild distress over the symptoms in Criterion A.
Moderate: Evidence of moderate distress over the symptoms in
Criterion A.
Severe: Evidence of severe or extreme distress over the symptoms in
Criterion A.

29. DD AND CO-MORBIDITY
Female Sexual interest/ Arousal
Disorder
Inadequate or Absent Sexual
stimuli.
Co-morbidity between sexual
interest/arousal problems and other
sexual difficulties is extremely
common. Sexual distress and
dissatisfaction with sex life are also
highly correlated in women with low
sexual desire. Distressing low desire is
associated with depression, thyroid
problems, anxiety, urinary
incontinence, and other medical
factors. Arthritis and inflammatory or
irritable bowel disease are also
associated with sexual arousal
problems. Low desire appears to be
co-morbid with depression, sexual and
physical abuse in adulthood, global
mental functioning, and use of alcohol.
Differential Daignosis Co-morbidity

30. GENITO-PELVIC PAIN/ PENETRATION DISORDER
A. Persistent or recurrent difficulties with one (or more) of the following:
1. Vaginal penetration during intercourse.
2. Marked Volvo-vaginal or pelvic pain during vaginal intercourse or penetration
attempts.
3. Marked fear or anxiety about Volvo-vaginal or pelvic pain in anticipation of, during, or
as a result of vaginal penetration.
4. Marked tensing or tightening of the pelvic floor muscles during attempted vaginal
penetration.
B. The symptoms in Criterion A have persisted for a minimum duration of
approximately 6 months.
C. The symptoms in Criterion A cause clinically significant distress in the individual.
D. The sexual dysfunction is not better explained by a nonsexual mental disorder or as
a consequence of a severe relationship distress (e.g., partner violence) or other
significant stressors and is not attributable to the effects of a substance/medication
or another medical condition.

31. SPECIFY
Specify whether:
Lifelong: The disturbance has been present since the individual became
sexually active.
Acquired: The disturbance began after a period of relatively normal sexual
function.
Specify current severity:
Mild: Evidence of mild distress over the symptoms in Criterion A.
Moderate: Evidence of moderate distress over the symptoms in Criterion A.
Severe: Evidence of severe or extreme distress over the symptoms in Criterion
A.

32. PREVALENCE
The prevalence of genito-pelvic pain/penetration disorder is unknown.
However, approximately 15% of women in North America report
recurrent pain during intercourse. Difficulties having intercourse
appear to be a frequent referral to sexual dysfunction clinics and to
specialist clinicians.

33. RISK AND PROGNOSTIC FACTORS
Environmental.
Sexual and/or physical abuse have often been cited as predictors of the
DSM-IV-defined sexual pain disorders dyspareunia and vaginismus.
This is a matter of controversy in the current literature.
Genetic and physiological
Women experiencing superficial pain during sexual intercourse often
report the onset of the pain after a history of vaginal infections. Even
after the infections have resolved and there are no known residual
physical findings, the pain persists. Pain during tampon insertion or
the inability to insert tampons before any sexual contact has been
attempted is an important risk factor for genito-pelvic
pain/penetration disorder.

34. DD AND CO-MORBIDITY
Genito-pelvic Pain Disorder
Another medical condition
Somatic symptom and related
disorders
Inadequate sexual stimuli.
Co-morbidity between genito-pelvic
pain/penetration disorder and other sexual
difficulties appears to be common. Co-
morbidity with relationship distress is also
common. This is not surprising, since in
Western cultures the inability to have (pain-
free) intercourse with a desired partner and
the avoidance of sexual opportunities may
be either a contributing factor to or the result
of other sexual or relationship problems.
Because pelvic floor symptoms are
implicated in the diagnosis of genito-pelvic
pain/penetration disorder, there is likely to
be a higher prevalence of other disorders
related to the pelvic floor or reproductive
organs (e.g., interstitial cystitis, constipation,
vaginal infection, endometriosis, irritable
bowel syndrome).
Differential Diagnosis Co-morbidity

35. MALE HYPOACTIVE SEXUAL DESIRE DISORDER
A. Persistently or recurrently deficient (or absent) sexual/erotic
thoughts or fantasies and desire for sexual activity. The judgment
of deficiency is made by the clinician, taking into account factors
that affect sexual functioning, such as age and general and soci-
cultural contexts of the individual’s life.
B. The symptoms in Criterion A have persisted for a minimum
duration of approximately 6 months.
C. The symptoms in Criterion A cause clinically significant distress in
the individual.
D. The sexual dysfunction is not better explained by a nonsexual
mental disorder or as a consequence of severe relationship distress
or other significant stressors and is not attributable to thes effects
of a substance/medication or another medical condition.

36. SPECIFY
Specify whether:
Lifelong: The disturbance has been present since the Individual became
sexually active.
Acquired; The disturbance began after a period of relatively normal sexual
function.
Specify whether:
Generalized: Not limited to certain types of stimulation, situations, or
partners.
Situational: Only occurs with certain types of stimulation, situations, or
partners.
Specify current severity:
Mild: Evidence of mild distress over the symptoms in Criterion A.
Moderate: Evidence of moderate distress over the symptoms In Criterion A.
Severe: Evidence of severe or extreme distress over the symptoms in Criterion
A.

37. PREVALENCE
The prevalence of male hypoactive sexual desire disorder varies
depending on country of origin and method of assessment.
Approximately 6% of younger men (ages 18-24 years) and 41% of
older men (ages 66-74 years) have problems with sexual desire.
However, a persistent lack of interest in sex, lasting 6 months or
more, affects only a small proportion of men ages 16-44 (1.8%).

38. RISK AND PROGNOSTIC FACTORS
Temperamental.
Mood and anxiety symptoms appear to be strong predictors of low desire in men. Up to
half of men with a past history of psychiatric symptoms may have moderate or severe
loss of desire, compared with only 15% of those without such a history. A man's
feelings about himself, his perception of his partner's sexual desire toward him,
feelings of being emotionally connected, and contextual variables may all negatively
(as well as positively) affect sexual desire.
Environmental.
Alcohol use may increase the occurrence of low desire. Among gay men, self-directed
homophobia, interpersonal problems, attitudes, lack of adequate sex education, and
trauma resulting from early life experiences must be taken into account in explaining
the low desire. Social and cultural contextual factors should also be considered.
Genetic and physiological.
Endocrine disorders such as hyperprolactinemia significantly affect sexual desire in
men. Age is a significant risk factor for low desire in men. It is unclear whether or not
men with low desire also have abnormally low levels of testosterone; however,
among hypogonadal men, low desire is conmon. There also may be a critical
threshold below which testosterone will affect sexual desire in men and above which
there is little effect of testosterone on men's desire.

39. DD AND CO-MORBIDITY
Male Hypoactive Sexual Disorder
Nonsexual mental disorders.
Substance/medication use
Another medical condition.
Interpersonal Factors
Other Sexual Dysfunctions
Depression and other mental
disorders, as well as endo-
crinological factors, are often
co-morbid with male
hypoactive sexual desire
disorder.
Differential Diagnosis Co-morbidity

40. PREMATURE (EARLY) EJACULATION
A. persistent or recurrent pattern of ejaculation occurring during
partnered sexual activity within approximately 1 minute following
vaginal penetration and before the individual wishes it. Note:
Although the diagnosis of premature (early) ejaculation may be
applied to individuals engaged in non-vaginal sexual activities,
specific duration criteria have not been established for these
activities.
B. .The symptom in Criterion A must have been present for at least 6
months and must be experienced on almost all or all
(approximately 75%-100%) occasions of sexual activity (in
identified situational contexts or, if generalized, in all contexts).
C. The symptom in Criterion A causes clinically significant distress
in the individual.
D. The sexual dysfunction is not better explained by a nonsexual
mental disorder or as a consequence of severe relationship distress
or other significant stressors and is not attributable to the effects of
a substance/medication or another medical condition.

41. SPECIFY
Specify whether;
Lifelong: The disturbance has been present since the individual
became sexually active.
Acquired: The disturbance began after a period of relatively normal
sexual function.
Specify whether:
Generalized: Not limited to certain types of stimulation, situations, or
partners.
Situational: Only occurs with certain types of stimulation, situations,
or partners. Specify current severity:
Mild: Ejaculation occurring within approximately 30 seconds to 1
minute of vaginal penetration.
Moderate: Ejaculation occurring within approximately 15-30 seconds
of vaginal penetration.
Severe: Ejaculation occurring prior to sexual activity, at the start of
sexual activity, or within approximately 15 seconds of vaginal
penetration.

42. PREVALENCE
Estimates of the prevalence of premature (early) ejaculation vary
widely depending on the definition utilized. Internationally, more
than 20%-30% of men ages 18-70 years report concern about how
rapidly they ejaculate. With the new definition of premature (early)
ejaculation (i.e., ejaculation occurring within approximately 1
minute of vaginal penetration), only l%-3% of men would be
diagnosed with the disorder. Prevalence of premature (early)
ejaculation may increase with age.

43. RISK AND PROGNOSTIC FACTORS
Temperamental:
Premature (early) ejaculation may be more common in men with
anxiety disorders, especially social anxiety disorder (social phobia).
Genetic and physiological:
There is a moderate genetic contribution to lifelong premature (early)
ejaculation. Premature (early) ejaculation may be associated with
dopamine transporter gene polymorphism or serotonin transporter
gene polymorphism. Thyroid disease, prostatitis, and drug
withdrawal are associated with acquired premature (early)
ejaculation. Positron emission tomography measures of regional
cerebral blood flow during ejaculation have shown primary
activation in the mesocephalic transition zone, including the ventral
tegmental area.

44. DD AND CO-MORBIDITY
Premature (Early) Ejaculation
Disorder
Substance/medication-induced
sexual dysfunction.
Ejaculatory concerns that do not
meet diagnostic criteria.
Premature (early) ejaculation may
be associated with erectile
problems. In many cases, it
may be difficult to determine
which difficulty preceded the
other. Lifelong premature
(early) ejaculation may be
associated with certain anxiety
disorders. Acquired premature
(early) ejaculation may be
associated with prostatitis,
thyroid disease, or drug
withdrawal (e.g., during opioid
withdrawal).
Differential Diagnosis Co-morbidity

45. SUBSTANCE/MEDICATION-INDUCED SEXUAL
DYSFUNCTION
A. A clinically significant disturbance in sexual function is predominant in the clinical
picture.
B. .There is evidence from the history, physical examination, or laboratory findings of
both (1)and (2): 1. The symptoms in Criterion A developed during or soon after
substance intoxication or withdrawal or after exposure to a medication. 2. The
involved substance/medication is capable of producing the symptoms in Criterion A.
C. The disturbance is not better explained by a sexual dysfunction that is not
substance/ medication-induced. Such evidence of an independent sexual dysfunction
could include the following: The symptoms precede the onset of the
substance/medication use; the symptoms persist for a substantial period of time
(e.g., about 1 month) after the cessation of acute withdrawal or severe intoxication;
or there is other evidence suggesting the existence of an independent non-
substance/medication-induced sexual dysfunction (e.g., a history of recurrent non-
substance/medication-related episodes).
D. The disturbance does not occur exclusively during the course of a delirium.
E. The disturbance causes clinically significant distress in the individual.
Note: This diagnosis should be made instead of a diagnosis of substance intoxication or
substance withdrawal only when the symptoms in Criterion A predominate in the
clinical picture and are sufficiently severe to warrant clinical attention.

46. SPECIFY
With onset during intoxication:
If the criteria are met for intoxication with the substance and the
symptoms develop during intoxication.
With onset during withdrawal: If criteria are met for
withdrawal from the substance and the symptoms develop
during, or shortly after, withdrawal.
With onset after medication use:
Symptoms may appear either at initiation of medication or after
a modification or change in use. Specify current severity:
Mild: Occurs on 25%-50% of occasions of sexual activity.
Moderate: Occurs on 50%-75% of occasions of sexual activity.
Severe: Occurs on 75% or more of occasions of sexual activity.

47. PREVALENCE
The prevalence and the incidence of substance/medication-induced sexual dysfunction are unclear,
likely because of underreporting of treatment-emergent sexual side effects. Data on
substance/medication-induced sexual dysfunction typically concern the effects of antidepressant
drugs. The prevalence of antidepressant-induced sexual dysfunction varies in part depending on
the specific agent. Approximately 25%-80% of individuals taking monoamine oxidase inhibitors,
tricyclic antidepressants, serotonergic antidepressants, and combined serotonergic-adrenergic
antidepressants report sexual side effects. There are differences in the incidence of sexual side
effects between some serotonergic and combined adrenergic-serotonergic antidepressants,
although it is unclear if these differences are clinically significant. Approximately 50% of
individuals taking antipsychotic medications will experience adverse sexual side effects,
including problems with sexual desire, erection, lubrication, ejaculation, or orgasm. The incidence
of these side effects among different antipsychotic agents is unclear. Exact prevalence and
incidence of sexual dysfunctions among users of nonpsychiatric medications such as
cardiovascular, cytotoxic, gastrointestinal, and hormonal agents are unknown. Elevated rates of
sexual dysfunction have been reported with methadone or high-dose opioid drugs for pain. There
are increased rates of decreased sexual desire, erectile dysfunction, and difficulty reaching orgasm
associated with illicit substance use. The prevalence of sexual problems appears related to chronic
drug abuse and appears higher in individuals who abuse heroin (approximately 60%-70%) than in
individuals who abuse amphetamines or 3,4-methylenedioxymethamphetamine (i.e., MDMA,
ecstasy). Elevated rates of sexual dysfunction are also seen in individuals receiving methadone
but are seldom reported by patients receiving buprenorphine. Chronic alcohol abuse and chronic
nicotine abuse are related to higher rates of erectile problems

48. DIFFERENTIAL DIAGNOSIS
Non-substance/medication-induced sexual dysfunctions. Many
mental conditions, such as depressive, bipolar, anxiety, and
psychotic disorders, are associated with disturbances of sexual
function. Thus, differentiating a substance/medication-induced
sexual dysfunction from a manifestation of the underlying
mental disorder can be quite difficult. The diagnosis is usually
established if a close relationship between
substance/medication initiation or discontinuation is observed.
A clear diagnosis can be established if the problem occurs
after substance/medication initiation, dissipates with
substance/medication discontinuation, and recurs with
introduction of the same agent. Most substance/medication-
induced side effects occur shortly after initiation or
discontinuation. Sexual side effects that only occur after
chronic use of a substance/medication may be extremely
difficult to diagnose with certainty.

49. OTHER SPECIFIED SEXUAL DYSFUNCTION
This category applies to presentations in which symptoms
characteristic of a sexual dysfunction that cause clinically significant
distress in the individual predominate but do not meet the full
criteria for any of the disorders in the sexual dysfunctions diagnostic
class. The other specified sexual dysfunction category is used in
situations in which the clinician chooses to communicate the specific
reason that the presentation does not meet the criteria for any
specific sexual dysfunction. This is done by recording “other
specified sexual dysfunction” followed by the specific reason (e.g.,
“sexual aversion”).

50. UNSPECIFIED SEXUAL DYSFUNCTION
This category applies to presentations in which symptoms
characteristic of a sexual dysfunction that cause clinically significant
distress in the individual predominate but do not meet the full
criteria for any of the disorders in the sexual dysfunctions diagnostic
class. The unspecified sexual dysfunction category is used in
situations in which the clinician chooses not to specify the reason
that the criteria are not met for a specific sexual dysfunction, and
includes presentations for which there is insufficient information to
make a more specific diagnosis.

51. CAUSES
Physical
 Diabetes
 Heart and Vascular Disease
 Chronic Diseases
Psychological
 Stress
 Anxiety
 Past and Present Relationship Issues

52. TREATMENT
 Long Term Psychodynamic Therapy (First half of the 20th Century)
 Behavior Therapy (1950’s & 1960’s)
 Couple Cognitive Behavioral Therapy (1970’s)
 Drug Therapy (Now)
 Avoid Smoking , Drinking, or drug use
 Education and Communication
 About sex and sexual behavior
 Create an open dialogue

53. REFERENCES
http://my.clevelandclinic.org/health/disease
http://www.everydayhealth.com/sexual-health
Diagnostic & Statistical Manual of Mental Disorders (DSM-V)
Comer,R.J.(2012). Abnormal Psychology. New York: Worth Publishers.